Sign Up

If you are a carer for someone who lives in the Windsor, Ascot or Maidenhead area please make yourself know to us by signing up below. Your contact details will enable us to keep you upto date with information that you may find useful in your caring role. Your privacy is important to us and we will never sell your contact details, for more information read our privacy policy.

The fields marked by * are required, the remainder are optional. Please provide at least one way for us to be able to contact you.

Your Details

First Name*Last Name*Telephone NumberEmailAddressWho do you care for?*What is your relationship? (Press Ctrl to select more than one)Please complete if you selected other aboveTheir name?Their date of birth?What do you do for them?*How many hours a week, on average, do you provide care and support?*How long have you been caring?*Does the person you care for have (Press Ctrl to select more than one)*Please complete if you selected other aboveWhich GP surgery are you registered with?Do you work or volunteer?If suitable support was available would you work or volunteer?How did you hear about us?

Royal Berkshire Fire and Rescue Service offer a free Home Fire Safety Check for anyone who meets one of the following criteria, is over 65 years of age, has mobility issues, receives support from social services or other care agencies, has any sight or hearing impairment or receives oxygen treatment at home. If you answered yes we will refer you to Royal Berkshire Fire and Rescue Service for a free home fire safety check.

Would you like a Free Home Fire Safety Check?

We collect the following information to enable us to be able to communicate with you in a way that suits your needs. From the 31st July 2016 all NHS and social care funded orgainsations should be communicating and providing people with information in a format that best suits their needs. See NHS Englands website for more details.

Do you require communication support? (Press Ctrl to select more than one)*What format should we give you information in? (Press Ctrl to select more than one)*How should we contact you? (Press Ctrl to select more than one)*Do you require a professional to assist with communication? (Press Ctrl to select more than one)*

The following demographics enable us to monitor if we are reaching the diverse population of Windsor, Ascot and Maidenhead. The completion of these are optional.